PERIAMPULLARY CARCINOMA - FACTORS INFLUENCING SURVIVAL

Background - Pancreaticoduodenectomy is the treatment of choice for pe riampullary carcinoma, The present study was undertaken to evaluate th e influence of histopathological risk factors and the efficacy of post operative adjuvant therapy on early recurrence and survival. Method - Twenty-nine patients who underwent pancreaticoduodenectomy for periamp ullary carcinoma and had a minimum follow-up of sis months were includ ed in the study, The degree of differentiation, resection margin invol vement, pancreatic infiltration and lymph node metastasis in the resec ted specimen were evaluated on histopathological review, Adjuvant ther apy was administered to 15 patients; it included 40-45 Gy of external radiotherapy (EBRT) and 5-Flurouracil (5-Fu) weekly for 12 cycles. Res ults - The site of origin was ampullary in 17, bile duct in six, duode num in four and pancreatic duct in two patients, Fourteen patients had ,yell differentiated tumors, Pancreatic infiltration was present in ni ne patients and eight patients had lymph node metastasis. Follow-up ra nged from 7-62 months (median 12 months), Recurrent disease developed in seven patients, The likelihood of recurrence was significantly incr eased in the presence of pancreatic infiltration (p = 0.001), lymph no de metastasis (p = 0.012) and moderate or poor differentiation (p = 0. 012) of the tumor, Six patients died during follow-up, Lymph node invo lvement was found to be the most significant risk factor adversely aff ecting survival (p = 0.04). Pancreatic infiltration also resulted in p oor survival (p = 0.06), whereas the degree of differentiation did not influence survival, There was a significant improvement of survival i n 15 patients who received adjuvant therapy (p = 0.038). Conclusion - Pancreatic infiltration and nodal metastasis adversely influence survi val and predict early recurrence, Adjuvant therapy with EBRT + weekly 5-Fu improves survival in patients with periampullary cancer.